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TREASURY DEPARTMENT 
UNITED STATES PUBLIC HEALTH SERVICE 

flUPERT BLUE, Surgeon General 



SOME OBSERVATIONS ON MENTAL 
DEFECTIVENESS AND MENTAL RE- 
TARDATION AMONG CHILDREN 



BY 

WALTER L. TREADWAY 

Passed Assistant Surgeon 
United States Public Health Service 



REPRINT No. 514 

FROM THE 

PUBLIC HEALTH REPORTS 
April 11, 1919 
(Pages 732-736) 




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WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1919 



Do of 3m 

iUL 30 1919 



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SOME OBSERVATIONS ON MENTAL DEFECTIVENESS AND 
MENTAL RETARDATION AMONG CfflLDREN,^ 

By Walter L. Treadway, Passed Assistant Surgeon, United States Public Health Service. 

Tlie popularity and simplicity of certain formal psychological 
tests has led some to rely implicitly on them for diagnosing the 
condition known as feeble-mindedness. By such a method an 
artificial standard has been fixed whereby an individual grading 
below a certiiin point has been classified as feeble-minded and above 
such a point as normal. In fact, however, at least among children, 
no distinct demarcation exists between the so-called higher typos 
of feeble-mindedness on the one hand and normal mentality on the 
other. Nature's method is one of gradation; shading, as it were, 
all her activities from one complexion to another. Moreover, the 
routine application of the form.al psychological tests by untrained 
persons m.aj^ readily lead to serious mistakes by classifying as feeble- 
minded, children whose mental development has merely been retarded. 

Binet^ and wSimon, in discussing the psj^chology of the feeble-minded 
child, point out that he does not resemble a normal child whose 
mental development is sir^iply retarded. In the case of the former, 
they say, the retardation has not been uniform, showing as an end 
result a greater development of intelligence in some respects than 
in others. Binet and Simon, therefore, conclude that the mental 
equipment of the feeblc-m.inded lacks equilibrium or proper bal- 
ance. They also state that feeble-minded children, while they 
resemble, by reason of retarded intellect, much younger normal 
children, show defects of reasoning, understanding, and imagination 
which do not appear in the latter. These authors are of the opinion 
that the mental powers of the feeble-minded child show individual 
peculiarities of a pathological kind. 

Howe claimed that mental defectives resemble the insane in that 
they both show intellectual or moral degradation or a combination 
of the two. Koffbauer thought this was true in the case of the 
higher grade mental defectives, because he considered that their 
powers of judgment were clouded with evil and because they had 
passionate attacks of anger. It appears that a number of classifi- 

« Reprint from the Public Health Reports, vol. 34, No. 15, Apr. U, 1919, pp. 732-736. 
'Binet and SLmon, '-Mentally Defective Children." Authorized translation by W. B. Drummond. 
Published by Edw. Arnold, 1911. 

117852°— 19 o 



4 MENTAL DEFECTIVENESS AMONG CHILDKEN. 

cations have been devised whicli confound insanity and mental 
deficiency. This confusion is partly explained by the fact that 
certain peculiarities of make-up or affective reactions which put 
the individuals out of harmony with their envhonment show a 
more or less low grade of intelligence when an intelligence scale or 
other psychological test for gradmg of intelligence is applied. The 
relationship, therefore, between the higher grade feeble-minded and 
the insane is closer than it would first apjDear to those unacquainted 
with psychiatric problems. 

There has long been an insistent demand on the part of psychia- 
trists that the facts be faced and that the existence of a borderland 
group which bridges the gap between a condition of feeble-mhidedness 
and normality be recognized. Among this borderland group are 
certain individuals whoso constitutional make-up is so badly 
adjusted to the demands of society that it brings them within the 
pm'view of the criminal code or leads to confhct with certam con- 
ventional standards. Among medical men, and especially those 
experienced in the care, treatment, and m.anagenient of the insane, 
it has long been recognized that a number of these borderland cases 
become insane in after life or are classed as so-called criminals whose 
paths may eventually lead to hospitals for the insane. This 
"psychopathic twilight zone" between feeble-mindedness and 
insanity on the one hand and normality on the other is, after all, 
spanned by a bridge of few arches. The understanding of them 
constitutes one of the many problems in mental hygiene and is a 
problem best to be solved by one having a knowledge of clinical 
psychiatry. Psychiatric knowledge is, therefore, to be regarded as 
an essential requisite for one who would diagnose the higher types 
of feeble-mindedness. But this is not all. The work demands, m 
addition, sound medical knowledge. 

A number of years' experience in the mental examination of 
American school cliildren has revealed the fact that manition and 
auditory defects retard proper mental development. Disorders of 
the nose and throat that induce inflammatory diseases of the middle 
ear also act indirectly as a cause of mental retardation. Those who 
deal with educational problems should therefore appreciate the 
fact that reliance can not be placed upon formal, psychological 
tests for diag.nosing the higher grade cases. In this connection it 
may be stated that the Binet-Sunon scale for gradmg intelligence 
(or its many modifications which have so many points in common) 
are fairly reliable for the pm'pose intended— the grading of intelli- 
gence. Moreover, although many things besides mental defective- 
ness modify the results of these tests, this is not a fault of the tests. 

The application of these tests to a large group of American school 
children living under varying social and economic conditions has 



MENTAL DEFECTIVENESS AMONG CHILDREN. 5 

shown that many nomial children — normal from the standpoint of 
school work — grade either one year in advance or one year behind 
their chronological age. Thus, it was found that the 6, 7, 8, and 9 
year old children graded either regular, one year advanced, or one 
year retarded. In the case of children 10, 11, and 12 years old, 
chronologically, large numbere graded either regular, one year 
advanced, or one or two years retarded. The 14, 15, and 16 year old 
children graded largely within the limits of 11 and 15 years, mentally, 
and those of 17 to 20 years of age graded from 12 to adult. 

The grading of children by these tests gives one, for educational 
purposes, and in a comparatively short time, an insight into their 
mental capacity. The results, moreover, are usually correct to 
within one year. To obtam similar results by observation methods 
usually requires a much longer period of time. It may therefore be 
concluded that the Bmet-Simon scale is a desu'able adjunct in the 
rapid classification of the intelligence of a group of individuals for 
pedagogical reasons and that it fulfills the need for which it was 
intended. 

The results of an intensive study conducted by the United States 
Public Health Service of 2,185 rural school children indicate that 
the limits of normal intelligence, as shown by grading with the 
Binet-Simon scale, become wider as the higher chronological ages 
are reached. With the approach of adolescence the mental equip- 
ment becomes more complex and is less accurately measured by 
an arbitrary scale than it is in early childhood. Thus it is found 
that children of 6 years who are 4, mentally, of 7 who are 5, of 8 who 
5 or 6, of 9 who are 6 or 7, of 10 who are 6 or 7, of 11 who are 7 or 8, 
of 12 or 13 who are 8 or 9, of 14 or 15 who are 9 or 10, of 16 who are 
10, of 17 to 20 who are 11, are classified as retarded children and 
are considered as a borderland feeble-minded group. Below this 
group are the definitely feeble-minded whose mental development 
will never be greater than that of a child. 

In this connection it is important to consider the age of the indi- 
vidual graded and to bear in mind the rate of mental progress which 
attends the different periods of life. Unfortunately there is at 
present no accurate means of measuring the rate of mental progress. 
It is well known, however, that the rate is rapid for the first few 
years of life, but becomes slower as maturity is approached. The 
difference in the mental development of a normal 2-year-old child 
and one 3 years old is readily recognized. This difference becomes 
difficult to note between the ages of 6 and 7, and between 11 and 12 
yearsof age the recognition of mental difterencesby ordinary observa- 
tion is quite impossible. Mental development during any one-year 
period does not represent accurately a imit of mental growth, 
because the older the child the less is the rate of mental development 
and the less noticeable is the retardation in any one-year age period. 



6 MENTAL DEFECTIVENESS AMONG CHILDEEN. 

v^Moreover, retardation in very young children presents two possi- 
bilities. In the fii'st place, when conditions are favorable owing to 
the greater number of years intervening before maturity, these 
children eventually may attain normal mental development. On 
the other hand, when conditions are unfavorable, retardation may 
accumulate and become increasingly evident with advancing age. 
In consequence, the ultimate mental development of young children 
thus classified can not be foretold. 

The problem is not so complex, however, in the case of adults or 
individuals who have reached a chronological age at which the rate 
of mental development is slower. Retardation below a certain point 
can not be overcome in the short time intervening before maturity 
at the slower rate of development, and the mental status in these 
cases may be determined with a fair degree of certainty. 

In attempting to decide whether or not a given case of retarded 
mental development is feeble-minded, inquiry is usually made as to 
possible hereditary influences. Heredity, no doubt, pla3^s a part as 
a cause of mental retardation, but exactly how this operates is p.ot 
at present clearly understood. In some of these individuals it may 
be found that one or more of the antecedents are insane, feeble- 
minded, epileptic, nervous, criminal, addicted to alcohol or drugs, 
or that they manifest other less marked, antisocial tendencies. On 
the other hand, a number of the antecedents may be found to be 
intellectually brilliant and to be playing an important part in shaping 
the progressive activities of a community. Moreover, it is not un- 
common to find that one or more brothers or sisters of these retarded 
cases are either mentally retarded or very brilliant; in the latter 
case bordering on genius. Unfavorable heredity, therefore, is not 
sufficiently understood to draw conclusions as to whether or not these 
retarded cases are definitely feeble-minded. It is a factor, however, 
and the person with such heredity should be regarded as possessing 
the so-called "neuropathic taint." 

A number of those v/ith this so-called neuropathic predisposition 
have been agitators of reforms that were considered irregular or far 
in advance of their time. Many of them appear to follow the by- 
paths of thought and seem to have a genius for looking at things in 
a different manner from that in which those untainted by such 
heredity look. In consequence they have left behind them gems in 
literature, music, and art, and have led and advocated social reforms 
that changed the moral conduct of man, and exercised good influences 
over his activities and thoughts. However, before conclusions can 
be reached in regard to the eventual mental outcome of the border- 
land cases, study and observation are necessary. It is already known 
that, among individuals who are classed as borderland cases, there 



MENTAL, DEFECTIVENESS AMONG CHILDREN. 7 

arc some in whom faulty habits of training are responsible for mental 
retardation. Environment also plays a part in its production, but 
how much and in what way it operates are not well understood. One 
need but turn to the history of democracy to find it replete with 
great men and women who have come from what is regarded as 
untowa,rd environments. Limited educational opportunities also 
play a part in the failure of certain individuals to score a high mark 
when graded by formal psychological tests. These are the cases that 
have been classed as "dull but not tainted." 

Therefore, before a mentally retarded individual is definitely diag- 
nosed as feeble-minded, it is necessary to learn something of his total 
mental make-up. This should include, besides a knowledge of his 
heredity, environment, and educational opportunities, an examina- 
tion of his grasp of general and school knowledge, his efforts or 
energy output, and, in fact, an understanding of his whole person- 
ality and developmental history, physical as well as mental. Such a 
knowledge is also important from the standpoint of understanding 
traits of character that are potentially good or bad for adaptation to 
the more or less complex situations of life. Moreover, it p,ermits the 
adoption of suitable training methods to develop the desirable traits 
and to restrain or overshadow the undesirable ones. 

During the past few years earnest efforts have been expended in 
the study of these traits of character, efforts which have pointed the 
way to a better understanding of the borderland cases. When 
this knowledge haa become perfected the psychopathic twilight zone 
will have been traversed and mental hygiene will have come to occupy 
an enviable position in preventive medicine. 



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